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Democrats and healthcare reform

Barak Obama's proposal marks a crucial turn in the healthcare debate.

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Sooner or later, the political argument about expanding access to healthcare always returns to the same intractable question: Who pays the bill?

The healthcare proposal that Democratic presidential hopeful Barack Obama released last Tuesday, though vague on many details, will sharpen that debate in illuminating ways.

Mr. Obama's plan is important first for what it is not. Like the other top Democratic presidential contenders, he rejects the left's growing support for a government-run, single-payer healthcare system. Instead, he proposes to reinforce the existing system, under which the vast majority of Americans receive coverage either through their employers or through government programs such as Medicare and Medicaid.

To cover most (but not all) of the roughly 45 million Americans without health insurance, Obama advances ideas that split the bill between individuals, government, and business. His first step would be to require parents to insure their children. Then he proposes to expand eligibility for government programs for the poor and to offer subsidies to help other uninsured individuals buy coverage through a new, nationwide purchasing pool modeled on the insurance available to federal employees. Finally, Obama would require all but the smallest employers to provide insurance for workers or else pay about 6 percent of their payroll to help the government fund the cost of covering those employees.

That last proposal marks a crucial turn in the healthcare debate. President Bill Clinton included a mandate for employers to insure their workers in the 1993 universal coverage proposal designed largely by his wife, Hillary Clinton. But, since small business groups helped sink the Clintons' plan, Democrats have shied away from such a mandate.


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